Regular exercise and vision screenings are among the strategies that significantly reduce older adults' risk of injuries from falls, according to a review of 54 studies published today in the Journal of the American Medical Association (JAMA).

This is important because every 20 minutes in the U.S., someone age 65 or older dies from a fall. In fact, falls are the most frequent source of injury for seniors, with more than one in four people 65 or older taking a spill each year, according to the Centers for Disease Control and Prevention (CDC). Seniors had more than 29 million falls in 2014 alone. And about 20 percent of falls cause a serious health issue such as a broken bone or head injury.

More on Senior Health

“A fall is often a life-changing event, the start of a downward spiral of increasing frailty and dependency,” says Eric Larson, M.D., M.P.H., executive director of the Kaiser Permanente Washington Health Research Institute, who wrote an editorial accompanying the study. And those who fall once are twice as likely to fall again, according to the CDC. So reducing the risk of falling is essential, Larson says.

In the new study, researchers looked at the effects of 39 fall-prevention interventions in previously published research involving almost 42,000 people. They found that four single or combination strategies were most effective.

“The greatest reduction—38 percent—was seen in people who exercised and had vision assessment and treatment to correct any vision issues,” says the study's author, Andrea Tricco Ph.D., an associate professor at the Dalla Lana School of Public Health at the University of Toronto. “But our study also shows that other strategies, such as environmental assessments and modifications, patient education, and taking calcium and vitamin D supplements also help.”

In addition, the researchers found that some of the interventions they looked at, including cognitive behavior therapy, dietary modifications, electromagnetic field therapy, and podiatry assessment and treatment, seemed to have little positive effect.

Here, what to know to prevent falls:

Know What Hikes Your Fall Risk

Advancing age is the most significant risk factor for falling, but several others can also increase susceptibility, Larson says. These include:

Poor vision. Age-related vision changes and eye diseases such as macular degeneration, diabetic retinopathy, glaucoma, and cataracts can affect your ability to navigate safely while walking.  

Medication side effects. Almost one-third of older adults in the U.S. take over-the-counter (OTC) or prescription sleep aids, which can cause next-day drowsiness, dizziness, and balance problems, and more than double the risk of falls and hip fractures. A number of other drugs may also raise fall risk, including anti-anxiety medications such as diazepam (Valium and generic) and lorazepam (Ativan and generic), and OTC diphenhydramine (Benadryl Allergy and generic). A May 2016 study of 90,127 older adults found a 36 percent increase in serious falls during the first 15 days after starting blood pressure medication.

Medical conditions. Anemia, inner-ear disorders, and low blood pressure can throw off your balance. Other conditions that may hike your fall risk include Parkinson’s disease, dementia, a history of stroke, and arthritis.

Protect Yourself From Dangerous Falls

According to the new study and to other experts, the following steps can improve your overall balance and help lower the likelihood of a potentially devastating fall.

Stay active. The new review found that all types of exercise help to prevent falls, possibly because most activity strengthens legs and enhances balance, Tricco says. One activity to consider is tai chi. Practicing this Chinese form of gentle exercise one to three times a week may slash your fall risk by half, according to a study published in July in the Journal of the American Geriatrics Society.  

Maintain good balance. If you have difficulty doing heel-to-toe walking (taking steps with one foot directly in front of the other) or you're unable to stand on one leg for at least 30 seconds, you may be at increased risk for falls, cautions Marvin M. Lipman, M.D., Consumer Reports' chief medical adviser. Have your doctor assess you for health conditions that can affect balance, like those mentioned in "Know What Hikes Your Fall Risk," above. He or she may also prescribe physical therapy to strengthen your muscles and improve your balance, flexibility, and endurance. (Here are basic balancing exercises from the National Institute of Aging.)

Take care of your vision. See an ophthalmologist or optometrist for a complete eye exam every year or two after the age of 65 to check for age-related eye diseases. If you’ve recently gotten multifocal eyeglass lenses, be aware that they can impair depth perception; you’ll need to take extra care to prevent falls until you get used to your prescription. The same goes for the first few weeks after cataract surgery. Your eyesight will improve, but it will take a bit of time to adjust to your new level of vision.

Assess your home. More than 75 percent of falls take place in or near the home, according to the National Council on Aging. The new review found that the combined strategy of assessing (and, when necessary, modifying) living environments for older adults, along with exercise and vision assessment and treatment was useful in reducing fall risk. Some quick and simple changes—such as fixing a broken handrail or removing throw rugs that may cause slips and trips—can enhance safety significantly. Find a whole-home hazard checklist here.

Bone up on calcium and vitamin D. The JAMA review found that getting sufficient amounts of these nutrients appeared to help reduce fall risk. “They have been linked to stronger bones, which may in turn lower chances of having a fall,” Larson explains. Adults between age 50 and 70 should get 1,000 mg of calcium and 600 IU of vitamin D each day. Those over the age 70 need 1,200 mg of calcium daily and 800 IU of vitamin D.

The best way to get calcium is through foods that are rich in the mineral, such as dairy products (a cup of plain low-fat yogurt or low-fat milk has around 300 mg), fortified foods such as oatmeal, and leafy greens like broccoli. Good sources of vitamin D include fatty fish such as salmon (with 447 IU in a 3-ounce serving, cooked), fortified milk, orange juice, and soy beverages. Because our bodies also make vitamin D when we're exposed to sunlight, our experts suggest getting 10 minutes of sunshine per day.

Review medications carefully. If you’re taking sleeping pills or anti-anxiety drugs regularly, or other medication that leaves you feeling groggy or off-balance, speak to your physician about how to safely wean yourself from them. If your doctor recommends any new medication, ask about side effects that could cause grogginess or balance problems.

Wear sturdy shoes. Opt for shoes with a heel collar and firm (not cushy) sole, which will help you feel the ground beneath you better and thus improve balance, even at home. “I bought my own parents slippers with hard soles like a tennis shoe to wear when they got up in the middle of the night to go to the bathroom, since that’s a prime time for falls,” Larson says. During the winter when it’s icy, consider slip-on ice cleats when you go outdoors for added traction that may prevent falls.